Bladder Infections: Signs, Symptoms, Treatment & Natural Remedies

What is a bladder infection?

A bladder infection—often called a urinary tract infection (UTI) or acute cystitis—occurs when bacteria enter the urethra and multiply in the bladder. Most cases are due to Escherichia coli (E. coli) from the gastrointestinal tract. Urine normally contains water, salts, and waste products, but no bacteria; when microbes adhere to the uroepithelial lining, inflammation and symptoms follow. Women are affected more often than men, partly because of a shorter urethra and proximity of the urethral opening to the anus and vagina. Sexual activity, certain contraceptives (e.g., diaphragms or spermicides), pregnancy, menopause-related changes, and urinary stasis can all increase risk.

Signs and symptoms of a bladder infection

• Frequent, urgent need to urinate (frequency and urgency)
  
• Burning or pain during urination (dysuria)
  
• Bladder spasms or suprapubic discomfort
  
• Feeling the need to pass urine even when little comes out
  
• Mild fever (sometimes)
  
• Cloudy, strong-smelling, or occasionally blood-tinged urine (hematuria)
  

Signs and symptoms of a kidney infection (pyelonephritis)

• Fever, chills, and nausea or vomiting
  
• Flank or back pain (just above the waist)
  
• Abdominal pain
  
• Frequency and burning with urination
  
• Cloudy or bloody urine
  

  Seek urgent medical care if you have fever, flank pain, vomiting, pregnancy, symptoms lasting more than 2–3 days, severe pain, visible blood in urine, or if you are immunocompromised. Kidney infections can cause complications and must be treated promptly.

Diagnosis

Diagnosis is based on history, symptoms, and a urine dipstick/urinalysis. A urine culture is recommended for recurrent infections, treatment failures, pregnancy, men, children, or concerning symptoms. Species-level identification and susceptibility testing help guide therapy when infections are persistent or recurrent.

Evidence-based treatment

• First-line antibiotics for uncomplicated cystitis typically include nitrofurantoin, fosfomycin, trimethoprim–sulfamethoxazole (when local resistance is low), and—newly added in the U.S.—pivmecillinam. Choice depends on local resistance patterns, allergy history, kidney function, and patient factors.
  
• Treatment duration is usually short: e.g., nitrofurantoin for 5 days, TMP-SMX for 3 days (where appropriate), fosfomycin as a single dose, or pivmecillinam for 3–7 days, per prescriber guidance.
  
• Complicated UTIs (e.g., in pregnancy, anatomic abnormalities, diabetes with systemic illness, catheter use) and pyelonephritis require clinician-directed therapy and occasionally imaging.
  
• Recurrent UTIs (rUTIs) may use induction to clear current infection followed by maintenance strategies (see prevention below). Vaginal estrogen is often recommended for postmenopausal women with rUTIs to restore the urogenital microbiome and reduce future episodes.
  

Natural prevention & supportive care

• Hydration: Aim for steady fluid intake across the day to increase urine flow and reduce bacterial dwell time.
  
• Cranberry products: Standardized cranberry juice or capsules can reduce recurrence risk in many women with frequent UTIs by limiting bacterial adhesion.
  
• D-mannose: Recent high-quality trials have not shown added benefit over usual care for preventing recurrent UTIs in primary care populations.
  
• Probiotics: Some evidence suggests potential benefit when used with standard care, but results are mixed and strain-specific.
  
• Methenamine hippurate: A non-antibiotic urinary antiseptic that can be considered for recurrent UTI prevention under clinician supervision.
  
• Hygiene & habits: Wipe front-to-back after bowel movements, urinate soon after intercourse, avoid prolonged holding of urine, and consider avoiding spermicides if prone to UTIs. Choose breathable underwear and change out of wet clothing promptly.
  

Tips to prevent bladder infections (everyday habits)

• Cleanse front-to-back after urination and bowel movements
  
• Empty the bladder regularly; avoid holding urine for long periods
  
• Urinate after sexual activity and gently wash the genital area
  
• Consider alternatives to spermicidal creams/diaphragms if you experience rUTIs
  
• Prefer breathable fabrics (e.g., cotton) and avoid prolonged damp garments
  
• Maintain adequate daily water intake
  
• Discuss cranberry products or methenamine with your clinician if you have recurrent UTIs
  

When to investigate further

• Women with recurrent infections (e.g., ≥2 in 6 months or ≥3 in 12 months) should be evaluated for modifiable risk factors and offered evidence-based prevention (vaginal estrogen after menopause, non-antibiotic prophylaxis, or targeted antibiotics).
  
• Men, children, or anyone with atypical features should be assessed for possible obstruction, stones, prostatitis, neurogenic bladder, or other underlying issues.

References

• FDA approval of pivmecillinam (Pivya) for uncomplicated UTIs – U.S. Food & Drug Administration press announcement (April 24, 2024): https://www.fda.gov/news-events/press-announcements/fda-approves-new-treatment-uncomplicated-urinary-tract-infections U.S. Food and Drug Administration
• Clinical overview of pivmecillinam as a first-line oral option – Clinical Infectious Diseases (advance article, 2025): https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaf280/8174614 OUP Academic
• Cranberry products reduce UTI risk (prevention) – Cochrane Review (2023): https://www.cochrane.org/evidence/CD001321_cranberries-preventing-urinary-tract-infections cochrane.org
• D-mannose not effective for preventing rUTI in primary care – JAMA Internal Medicine RCT (2024): https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2817488 JAMA Network
• Methenamine hippurate non-inferior to daily antibiotics for rUTI prophylaxis (ALTAR trial) – BMJ (2022): https://www.bmj.com/content/376/bmj-2021-0068229 bmj.com
• AUA guideline: Recurrent Uncomplicated UTIs in Women – American Urological Association (2019 guideline; updates and summaries 2022–2025): https://www.auanet.org/guidelines-and-quality/guidelines/recurrent-uti
• Vaginal estrogen to reduce rUTIs in postmenopausal women – AUA clinical guidance for GSM: https://www.auanet.org/guidelines-and-quality/guidelines/genitourinary-syndrome-of-menopause
• IDSA practice guideline (foundational) for acute uncomplicated cystitis & pyelonephritis – Clinical Infectious Diseases (2011): https://www.idsociety.org/practice-guideline/uncomplicated-cystitis-and-pyelonephritis-uti/ idsociety.org

This educational content does not replace medical advice. Always consult a qualified healthcare professional for diagnosis and personalized treatment.